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Hospital Length of Stay After Admission for Traumatic Injury in Canada: A Multicenter Cohort Study

Moore, Lynne PhD*,†; Stelfox, Henry Thomas MD, PhD, FRCPC; Turgeon, Alexis F. MD, MSc, FRCPC*,§; Nathens, Avery MD, PhD; Bourgeois, Gilles MD; Lapointe, Jean MD; Gagné, Mathieu MSc*; Lavoie, André PhD

doi: 10.1097/SLA.0000000000000624
Original Articles

Objective: To describe acute care length of stay (LOS) over all consecutive hospitalizations for the injury and according to level of care [intensive care unit (ICU), intermediate care, general ward], compare observed and expected LOS, and identify predictors of LOS.

Background: Prolonged LOS has important consequences in terms of costs and outcome, yet detailed information on LOS after trauma is lacking.

Methods: This multicenter retrospective cohort study was based on adults discharged alive from a Canadian trauma system (1999–2010; n = 126,513). Registry data were used to calculate index LOS (LOS in trauma center with highest designation level) and were linked to hospital discharge data to calculate total LOS (all consecutive hospitalizations for the injury). Expected LOS was obtained by matching general provincial discharge statistics to study data by year, age, and sex. Potential predictors of LOS were evaluated using linear regression.

Results: Mean index and total LOS were 8.6 and 9.4 days, respectively. ICU, intermediate care unit, and general ward care constituted 8.9%, 2.5%, and 88.6% of total hospital days. Observed mean index and ICU LOS in our trauma patients were 2.9 and 1.3 days longer than expected LOS (P < 0.0001). The strongest determinants of index LOS were discharge destination, age, transfer status, and injury severity.

Conclusions: Results suggest that acute care LOS after injury is underestimated when only information on the index hospitalization is used and that ICU or intermediate care constitute an important part of LOS. This information should be used to inform the development of an informative and actionable quality indicator.

This multicenter cohort study describes the distribution and determinants of hospital length of stay (LOS) after trauma. Results suggest that information on multiple hospital stays and on the level of care provided (intensive, intermediate, or general ward) should be considered when evaluating trauma center care.

*Department of Social and Preventative Medicine, Université Laval, Québec, Canada;

Unité de traumatologie-urgence-soins intensifs, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, Canada;

Department of Critical Care Medicine, Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada;

§Department of Anesthesiology, Division of Critical Care Medicine, Québec, Canada;

Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto; and

Institut national d'excellence en santé et en services sociaux, Montréal, Québec, Canada.

Reprints: Lynne Moore, PhD, Research Center of the CHU de Québec (Hôpital de l'Enfant-Jésus), Traumatologie–Urgence–Soins Intensifs (Trauma–Emergency–Critical Care Medicine Unit), 1401, 18e rue, local H-012a, QC G1J 1Z4. E-mail: lynne.moore.cha@ssss.gouv.qc.ca

Disclosure: Canadian Institutes of Health Research: young investigator award (H.T.S. and L.M.) and research grant (L.M.; 110996); Fonds de la recherche du Québec - Santé: clinician-scientist award (A.F.T.). The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.